Training for Residents Integrating Skills, Treatment Advocacy and Resilience for Mental and Behavioral Health (TRI-STAR-MBH)
Project Overview & Rationale
In the 2023-2024 academic year, SFPC is expanding our mental health curriculum. Our enhanced mental health curriculum is called Training for Residents Integrating Skills, Treatment Advocacy and Resilience for Mental and Behavioral Health (TRI-STAR). In late 2022, we received a grant from the Health Resources and Services Agency (HRSA) to support the development of this program. TRI-STAR is guided by multidisciplinary faculty who offer expertise relevant to the prevention and management of mental health conditions in a large network of safety net clinics, partnering with community-based organizations, to serve a diverse, medically, and socially complex population, with a focus on the prevention, identification, diagnosis, and treatment of mental and behavioral health conditions affecting populations experiencing trauma, gun violence, substance use disorders and chronic mental illness. Our outstanding faculty educators include national experts in medical education, curricular development, psychiatry, psychology, addiction and behavioral medicine, adolescent mental health, maternal health, and behavioral integration in primary care.
Why expand our mental health curriculum?
- Primary care physicians are on the front lines of access to mental health services, screening, diagnosis and treatment. Most patients receive behavioral health care in their primary care clinic alone.
- Inequities in access to mental health care disproportionately impact people of color and those with low socioeconomic status so for PCPs serving people in these demographics, providing evidence-based mental health treatment is particularly important.
- Depression, anxiety, insomnia and other mental health conditions are among the most commonly encountered visit diagnoses in RFPC, the San Francisco Health Network and primary care practices nationwide.
- SFPC alumni have indicated in a recent survey that they commonly encounter and manage many mental health conditions in practice. Most SFPC alumni surveyed agreed they would recommend more training and practical skills in the screening, diagnosis and management of these conditions for primary care trainees.
- Our program leadership and many other primary care program directors nationwide feel it is imperative for future PCPs to leave residency equipped with the knowledge and skills to screen for, diagnose and offer treatment for common mental health conditions.
Mission & Objectives
Increase the number of primary care physicians who are trained in the prevention, identification, diagnosis, treatment, and referrals for mental and behavioral conditions.
Develop or expand partnerships with integrated behavioral health and primary care settings and community-based organizations to provide clinical rotations for at least one month in duration for primary care residents.
Develop or enhance mental and behavioral health content in didactic and clinical training for primary care residents including suicide prevention, trauma-informed care, addressing abuse, and gun violence
TRI-STAR Curriculum Overview
The TRI-STAR longitudinal curriculum is composed of a series of didactics and workshops that will start on a limited basis in intern year, and will be delivered during each outpatient block in R2 and R3 years. These didactics and workshops will be accompanied by experiential learning with rotations in RFPC doing psychiatry consults with Dr. Luther Arms, and some residents will also rotate at specialty mental health clinics including Chinatown North Beach Mental Health, Mission Mental Health and Citywide Case Management Services.
Visual representation of TRI-STAR curriculum:
Lisa Ochoa-Frongia, M.D. is a clinician-educator and Associate Professor of Medicine at UCSF, in the Division of General Internal Medicine at San Francisco General Hospital (SFGH). Dr. Ochoa-Frongia is a practicing primary care physician and Associate Program Director for the ZSFG Primary Care General Internal Medicine Track of the UCSF Internal Medicine Residency Program (SFPC). She is also the former Associate Medical Director of Richard Fine People's Clinic and Ambulatory Site Director for the UCSF Internal Medicine Residency at SFGH. Dr. Ochoa-Frongia is a proud graduate of SFPC and is passionate about resident education, social justice, mental health within primary care and helping people achieve wellbeing through health care. Outside of work, she loves spending time with her family including her husband and two sons, hiking and cooking.
Dr. Ochoa-Frongia's scholarly interests include best practices in the treatment of mental and behavioral health conditions in primary care, behavioral health integration in safety-net clinics, curricular development and mental health curricula for primary care providers. She is the PI for a 5-year HRSA Training Enhancement award for a project entitled Training for Residents Integrating Skills, Treatment, Advocacy and Resilience for Mental and Behavioral Health (TRI-STAR). Through this project, she is working with a team of outstanding UCSF faculty members to enhance the SFPC mental health curriculum.
SFPC Program Director
Dr. Joan Addington-White is a Professor of Medicine with the UCSF Department of Medicine at the Division of General Internal Medicine at Zuckerberg San Francisco General Hospital. She is the Residency Director for the San Francisco General Hospital Primary Care Internal Medicine Training Program (SFPC). SFPC is the pre-eminent public hospital training program in the country, whose mission is to train future leaders in clinical care, research, policy, education and systems administration to promote health and healthcare for vulnerable and underserved patient and communities.
Psychology, Substance Use and Behavioral Medicine
Jason Satterfield, PhD, is the Academy Endowed Chair for Innovation in Teaching, Director of Behavioral Medicine and Professor of Clinical Medicine in the Division of General Internal Medicine at the University of California San Francisco. He received his B.S. in brain sciences from MIT and his Ph.D. in clinical psychology from the University of Pennsylvania. Dr. Satterfield's current interests include the integration of behavioral science in health professions education, dissemination and implementation of evidence-based behavioral practices in primary care, and emerging mobile health technologies for behavioral health with a particular focus on smoking and substance use disorders. His current projects include training and implementation of medication-assisted treatment for opioid use disorders, the development and administration of the National Center for Tobacco Free Recovery, screening and brief interventions for substance misuse and tobacco, hybrid digital interventions for chronic pain, and the integration of social and behavioral sciences in medical, nursing, and social work curricula.
Psychiatry and Classroom Teaching
Emma Samelson-Jones, MD, is an associate professor with the UCSF Department of Psychiatry and Behavioral Sciences. She is a member of the Haile T. Debas Academy of Medical Educators at UCSF and is interested in curriculum development and teaching focused on improving the mental health care provided by primary care providers. She received the Faculty Innovation in Teaching Award from the American Board of Psychiatry and Neurology to create PsychSnaps (psychsnaps.com), a longitudinal medical education program to help PCPs take better care of their patient’s mental health. Dr. Samelson-Jones holds a joint appointment in the Department of Medicine in recognition of her work as a general adult psychiatrist with the UCSF General Medicine Clinic. She co-directs the Behavioral Medicine Seminar for UC Primary Care Residents, provides clinical case consultation to primary care faculty and residents, and is a frequent speaker at CME presentations for PCPs.
Psychiatry and Clinical Teaching
Luther Arms, MD is an Assistant Clinical Professor in the Department of Psychiatry and Behavioral Sciences at UCSF/Zuckerberg San Francisco General Hospital. He provides integrated behavioral health care in the Richard Fine People's Clinic, a large general medicine clinic at ZSFG and psychiatric care for patients with serious mental illness at Citywide Case Management, the largest intensive case management agency in San Frnacisco. In addition, he is dual-boarded in internal medicine and psychiatry. His clinical interest are in collaborative care, medical comorbidities for patients with serious mental illness, systems-based care, quality improvement and graduate medical education.
Chuan Mei Lee, MD, MA, is an Assistant Clinical Professor in the Department of Psychiatry and Behavioral Sciences at UCSF. She works clinically as a consulting child and adolescent psychiatrist in pediatrics primary care at Zuckerberg San Francisco General Hospital. She is also an Associate Director and the Director of Research and Program Evaluation at the UCSF Child and Adolescent Psychiatry Portal, which provides remote psychiatric consultation services to pediatric primary care providers. Her clinical and research interests include: scaling up mental health services delivery, integration of mental health services in pediatric primary care, and providing access to quality care for vulnerable populations.
Mental Health Integration and Implementation
Maria E. Garcia, MD, MPH, MAS, is a clinician-investigator with a focus on co-morbid mental health and chronic disease and their disproportionate impact on vulnerable and marginalized populations. As an Assistant Professor in the Division of General Internal Medicine, she conducts research on mental health integration in primary care, with a focus on racially, ethnically and linguistically diverse populations. Dr. Garcia completed residency training in Internal Medicine at UCSF, in the San Francisco General Hospital Primary Care Program, and subsequently the UCSF Primary Care Research Fellowship. During her fellowship, she developed an interest in improving mental health service delivery for individuals with limited English proficiency. Dr. Garcia has researched the unique challenges that patients with co-morbid mental health and chronic diseases face and focused on implementation work in mental health integration and improvement of service delivery for populations with language barriers.
Trauma Informed Care
Leigh Kimberg, MD, is a Professor of Medicine at the University of California, San Francisco (UCSF) She has practiced primary care internal medicine in the safety net in San Francisco for over 25 years; currently she cares for patients in the Richard H. Fine People’s Clinic at SFGH. Dr. Kimberg served as the Program Director for PRIME-US, a medical education program designed to promote health equity and social justice. Dr. Kimberg’s areas of expertise include interpersonal violence prevention, healing-centered and trauma-informed care, and medical education. Dr. Kimberg is the Interpersonal Violence Prevention Coordinator for the San Francisco Department of Public Health (SFDPH), serves on the San Francisco Family Violence Council, and directs a program called ARISE (Aspire to Re-Imagine Safety and Equity) launched through federal funding from the US Department of Health & Human Services; ARISE aims to build and evaluate multi-sector university-healthcare-community partnerships to prevent and mitigate trauma, support resilience, and promote health equity and social justice. She was on the California Surgeon General’s Clinical Advisory Sub-Committee to launch the ACES Aware initiative and the Clinical Advisory Committee of the CALQIC Initiative that was tasked with building a statewide clinical learning collaborative for ACES Aware.
Maternal Health and Teratogenic Risks
Eleanor Bimla Schwarz, MD, is a general internist and health services researcher whose work centers on harm reduction and health promotion. She has a particular interest in identifying ways to better meet the needs of diverse, vulnerable populations, including women with chronic medical conditions and other underserved populations. Her research, which has been funded by HRSA, PCORI, AHRQ, FDA, NICHD, the Office of Population Affairs, and the Office of Adolescent Health, has produced over 175 peer-reviewed publications. An award-winning mentor, she has worked closely with multiple junior faculty on career development awards, as well as with a range of postdoctoral fellows, graduate and undergraduate students.
A proud product of California’s public school system, Dr. Schwarz received her undergraduate and master’s degrees from the University of California, Berkeley prior to receiving her medical degree from UCSF. She completed residency training in primary care internal medicine at UCSF, and a fellowship in women’s health and health services research at the San Francisco VA. Previously, Dr. Schwarz served as Medical Consultant for California’s Department of Health Care Services’ Office of Family Planning, Senior Medical Expert in Reproductive Health for the U.S. Department of Veterans Affairs, and a member of the FDA's Advisory Committee on Reproductive Health Drugs. Prior to returning to UCSF, Dr. Schwarz was tenured at the University of Pittsburgh and the University of California, Davis, where she led the Quality, Safety, and Comparative Effectiveness Research Training in Primary Care fellowship. Dr. Schwarz currently serves on the council of the Society of General Internal Medicine (SGIM) and is an Associate Editor of NEJM Journal Watch. Dr. Schwarz loves clinical teaching in both inpatient and primary care settings and is committed to encouraging consideration of the social determinants of health while fostering collaboration and the growth of the next generation of clinicians and scholars.
Behavioral Health Integration, Experiential Learning
Anne Rosenthal, MD, is a Clinical Professor of Medicine at UCSF. Dr. Rosenthal is a primary care provider and is also the Medical Director of Richard Fine People’s Clinic. She has been practicing in the Bay Area safety net for over 30 years. Dr. Rosenthal is interested in health equity, healthcare systems improvement, clinical quality improvement, and developing the public health primary care pipeline of staff and providers. Clinically, she is interested in medical care for patients with serious mental illness (SMI) and expanding primary care capacity to care for patients with SMI. Dr. Rosenthal lives in SF with her partner, two teens, and two cats. She loves hiking, camping, road tripping, running, biking, gardening, and trying to keep up with the news.
Health Equity and Population Health
Alicia Fernandez, MD, is Professor of Medicine at UCSF, a general internist at Zuckerberg San Francisco General Hospital, Associate Dean of Population Health and Health Equity for UCSF SOM. She is the founding Director of the UCSF Latinx Center of Excellence, a HRSA and UCSF funded initiative to increase academic diversity. Dr. Fernandez directs the Latinx and Immigrant Health Research Program at the UCSF Center for Vulnerable Populations. which generates actionable research to increase health equity and reduce healthcare disparities.
Dr. Fernandez' research expertise includes language and literacy barriers in healthcare, health
care equity in chronic disease, particularly diabetes, and racism in medicine. Dr. Fernandez has served on the National Academy of Science Roundtable on Health Literacy since 2014. Dr. Fernandez is on the Board of Governors and Chair of the Science Oversight Committee at the Patient Centered Outcomes Research Institute (PCORI). Since 2020, she serves on the Board of Directors of the American Board of Internal Medicine. At UCSF, Dr. Fernandez is a member of the UCSF Academy of Medical Educators. Along with colleagues at UCSF, she edits the textbook, Medical Management of Vulnerable and Underserved Patients (Lange,2nd edition).
Anti-Oppressive Curricula and Medical Education
Kate Lupton, MD, is a Professor of Medicine at UCSF, a general internist at Zuckerberg San Francisco General Hospital. Dr. Lupton's educational interests include ambulatory and primary care education for medical students and residents, anti-racism and anti-oppression, equity and belonging in medical education, physician workforce diversity and the clinical care of underserved and vulnerable patients. She is a core preceptor for medicine residents with continuity clinic at ZSFG and serves as a Resident Advising and Development (RAD) coach with the medicine residency program. She is Director of SPAN (Specialty Practice Ambulatory Sub-Internship), a required longitudinal ambulatory capstone clerkship for 4th year UCSF medical students. Dr Lupton directs the Health Professions Education pathway for Graduate Medical Education, a longitudinal development program for trainees in UME and GME interested in incorporating education in their careers.
Dr. Lupton is strongly committed to improving the climate for diversity, equity, inclusion and belonging, to advancing equity and anti-racism, and to increasing physician workforce diversity. She has served on several Department and School of Medicine committees examining these issues at UCSF. She was selected as a 2016 John A. Watson Faculty Scholar and has used this opportunity to collaborate on the implementation of holistic review in intern selection for the UCSF internal medicine residency program.
Jonathan Ballard, MA, is as an Administrative Officer for the division working closely with the administrative team and supporting the Division Chief, Dr. Bimla Schwarz, in her leadership role as well as in her work in women's health, health services research, and ways to better meet the needs of diverse and vulnerable populations. He works with DGIM Manager and Asst. Manager to provide administrative and operational support to the Division’s faculty and staff. Jonathan also is the Program Coordinator for SFPC Primary Care Residency Program. Jonathan graduated from the University of California, Davis with a B.S. in Community and Regional Development and earned his M.A. in Higher Education focused in leadership and policy studies from California State University, Sacramento. Prior to joining the DGIM team, he worked at UC Davis Health as a fellowship coordinator supporting a HRSA funded T32 grant. His previous experience also includes working in student services, academic support systems, and on recruitment and retention efforts.
Research and Dissemination Analyst
Cristina Calderon, BA, is dually appointed in the Department of Psychiatry and Behavioral Sciences and the Division of General Internal Medicine. Cristina supports projects on behavioral health integration, depression care initiatives, as well as research and education with funding through HRSA and the California Healthcare Foundation. Cristina has been involved in the study Latinx Depression Care During COVID-19: Needs, Challenges, and Attitudes in the SF Bay Area, the Bring It Up! Depression management program at RFPC, and the ARCHES Mid-Career Faculty Development Program. Most recently, her work at UCSF has included the development of a free online module on evidence-based depression diagnosis, treatment, and care best practices for safety-net PCPs.